Covid Care and In Network Hospital Treatment? [NY]

[dayofgrace]

Hi everyone,

So this is going to sound really stupid probably, but I’ve got kind of a fundamental question regarding what constitutes as “In Network” hospital care.

So here are my questions,

Are hospital systems and HI providers treating “In Network” any differently due to the Pandemic?

If I sign up for a HI plan that has a limited network and I manage to contract Covid and require respiratory care and a hospital stay, what happens if my “In Network” hospital systems tell me “Sorry Hospital is full right now, we don’t have the capacity to accept any more patients”?

Does my HI Provider give me any flexibility then for treatment in what is essentially an Emergency Pandemic Situation? If the only place I can possibly be admitted is “Out of Network” would they possibly give me a break on billing?

And now for a really dumb question, are the exchange plans organized by county for the sake of COST only but not restrictions on network? In other words, if I couldn’t be admitted to an “In Network” Hospital in my county, could I go to one in the neighboring County? According to a local agent’s website with plan comparisons, that increases my options from 3 to 7 in the particular plan I am interested in.

The reason I am asking is because I’m currently living on Long Island, NY, and while the transmission rate is hovering around .8% and we are doing great in that regard and loosening restrictions, I have certainly not forgotten what happened here in March and April. Because of our sheer population numbers I wouldn’t rule out the idea that we get a Second Wave at some point. I am enrolling in an individual plan instead of rolling the dice on having a gap or back paying Cobra solely for this reason.

I recently officially resigned from my previous job where I had been furloughed since the end of March and had very little hope of being recalled to, and accepted a new objectively better job with a different company a couple weeks ago. I won’t be eligible to join their plan until Oct 27th though. So right now I am shopping for Individual Coverage ACA plans to cover me during that gap. My Cobra would cost me almost $900 a month which is hard to swallow, while a Silver Exchange plan would run me about $650 for the plans I am considering. The only issue that I am seeing, is that the hospital systems in their EPO or HMO network are a bit “stingy”. These are smaller locals, not Norwell Health, Mt. Sinai, Stony Brook Univ, etc. When I look up stats online their bed counts are in the 100 – 250 range per facility. If I am able to go to a hospital in the neighboring county or wherever I am allowed to go in a Pandemic Emergency, then I’m not as worried about network size.

 

[resjudicata]

@dayofgrace Do some additional research on your desired health insurance plan's COVID response, if any. Many insurers announced that there will be no out of pocket expenses for members who require COVID treatment. At that point, you wouldn't need to be concerned about bed count at in network and out of network hospitals and I think NY has balance billing legislation.

 

[dayofgrace]

@resjudicata Thanks for the suggestion.

So Oscar said the following on their site which was essentially what I was hoping to hear:

"For those of you who need treatment, we’ve waived the cost of treatment related to the illness delivered by in-network providers through September 30, 2020. If you’re treated at an out-of-network facility, we’ll also waive the cost through September 30, 2020, as long as you’ve gotten prior-authorization. You need to have a positive diagnosis for COVID-19 for your care to be covered. You can obtain prior authorization by having your provider contact us as soon as reasonably possible. (There are just a few exceptions and notes which are noted at the bottom.)"

I'm going to have to call Health First to see if they are offering similar.

 

[lizzie18]

@dayofgrace New York State of Health Plans are regional, meaning the in-network providers are largely in specific counties near you. Part of this is licensing (e.g. BlueCross licenses different companies for different regions) and part is expansion (e.g. Oscar only works downstate and MVP upstate).

Per the ACA things truly classified as emergencies are in-network regardless of hospital. That means in your case for example that respiratory care is urgently needed or you feel persistent shortness of breath. It would also be worthwhile checking if Urgent Care is treated the same for out and in network. That way you could go to an urgent care that is seeing suspected Covid cases for less than the hospital. They can also write ER referrals if needed.